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Rehold Partap 2018 MIAMI-UDE OUTSIDE EMPLOYMENT STATEMENT COUNTY For Full-time County and Municipal Employees Full-time County(including Public Health Trust)and municipal employees engaging in outside employment must file an annual disclosure report by July 1st of each year, in accordance with Section 2-11.1(k)(2)of the Miami-Dade County Code. Disclosure for Tax Year Ending Last Name Fir ame Middle Name/Initial 2018 /(Cr' P CA/OG 9 Mailin Address-Street Number,S rt eet Name,or P.O.Box 'o 00 .S'- t'..3 3 7 -/h per c.c(• City,State,Zip D '�( C�1 / Tic /' ' y e? If your home address is exempt from public records pursuant to Florida Statutes§119.07,please see note on the following page and check here.0 Filing as an Employee(check one) 0 County 0 Public Health Trust QM1 nicipal C/� /]_y ©/4- M n/ 86ac N (Municipality) Department Division Pefee./C <,)oiu) Farl- f)r Position or Title Employee ID Number Work telephon e Ae Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other compensation you received for each source of outside employment. If no income or compensation was received from a particular outside employment,enter zero(0)for that organization in the section below. If continued on a separate sheet,check here. ❑ Name and Address Nature of the Total Amount of Money or of the Source of Outside Income Work Performed Compensation Received44.0,20 tI/ (•',c. j of �i/((S (iJ(,c a(4)6( f-9 I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: > ❑Hardcopy -cc ❑ ElectReCEIVED lc Signature of Person Disclosing JUL 15 ?),H 2d'—/5' CITY OF MIAMI BEACH Date signed OFFICE OF THE CITY CLERK OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138_01-22 COE 2016